8 Comments

Barn Owl

Ow, that disc fragment looks as if it impinges on nerve roots. Hope you can get some relief soon. Are those dark strands in the vertebral canal a few of your cauda equina?
Would you mind if I used that image (sans any identifying info) in my lecture to the freshman medical students on vertebral column, spinal cord, and back muscles? I have a couple of transverse section images, but none as good as that for parasagittal.

PalMD

You’re welcome to use my images, although since I don’t really know my MR anatomy very well, you’re good to double check me.
I wouldn’t mind a shout-out if you use them, but either way go ahead.
I have no cauda equina symptoms, mostly L5 and some S1 symptoms.

David

as a neurologist who’s seen many patients with similar problems, and as a former patient with the same problem, you have my sympathy.
you might want to check out the American Pain Society Guidelines, available at http://www.annals.org/cgi/content/full/147/7/478
recommendation 4 maybe of interest to you:
“The natural history of lumbar disc herniation with radiculopathy in most patients is for improvement within the first 4 weeks with noninvasive management. There is no compelling evidence that routine imaging affects treatment decisions or improves outcomes. For prolapsed lumbar disc with persistent radicular symptoms despite noninvasive therapy, discectomy or epidural steroids are potential treatment options.”
The tricky part of the recommendation is deciding when you’ve gotten into that “persistent radicular symptoms” phase.
Best wishes.

Barn Owl

Thank you, PalMD; I’ll definitely reference your blog on the lecture slide. I suspect that more than a few of the medical students will really enjoy reading blogs written by physicians (and some of them may already follow the medical blogosphere).

D. C. Sessions

Software: the GIMP is free, and very good. Different UI from the Adobe stuff, but it’s equally capable.
The image: There seems to be a screaming shortage of redistributable medical imagery on the Net. $HERSELF is a very good amateur photographer, and is seriously annoyed that the images I uploaded to WikiMedia of a recent fracture are getting more downloads than her very good photographs.
Your choice, Doctor, but it could help people and do some education.

Elissa

Oof. Even without being a doctor, I can tell that doesn’t look good! You have my sympathies. In the meantime, if you are moving around the hospital with a cane, and if you’re really cranky, do people get to call you Dr. House?